TACKLING SELECTIVE MUTISM

Often referred to as ‘social phobia’s cousin’, Selective Mutism is an anxiety disorder in which the phobia of talking prevents children from speaking in social situations.  As with many communication disorders, there are grey areas that make Selective Mutism difficult to explain to parents and teachers, leading to the condition being undiagnosed, mismanaged and misunderstood until the child starts school.

 

The Diagnostic and Statistical Manual of Mental Disorders estimates that Selective Mutism affects 1 in 1,000 children referred for mental health treatment (APA, 2000).  In the UK, it is estimated that Selective Mutism affects 1 in 150 children, and that most primary schools will have at least one child affected by the disorder and Dr. Elizabeth Woodcock of the Selective Mutism Clinic in Australia claims that 1 in 100 children in their first three years of school is thought to have Selective Mutism.

 

Experts believe the condition may be genetic, but can also be triggered by traumatic events or ongoing difficulties such as divorce. Some experts believe children developing dependency on parents and caregivers contributes to the increase of Selective Mutism, as well as the use of gestures and whiteboards to avoid anxiety brought on by speaking. 

 

It is possible for children to remit without treatment, however, in more severe cases, the failure to speak can persist into adolescence or early adulthood.

 

Signs and symptoms

 

The rate of Selective Mutism diagnosis is comparable to depression, and higher than that of autism. However, not all children with Selective Mutism fit neatly into the diagnostic criteria. It is commonly misdiagnosed as autism or ADHD before the child completely stops talking. Three dominant features of Selective Mutism are:

 

• Social anxiety

• Oppositional behavior

• Communication difficulties.

 

Other key features are attention-seeking behavior and compensatory behaviour.

 

 

The prognosis of treatment depends on the strength of the therapeutic relationship and understanding of what motivates the child to step out of his comfort zone.  However, it is known in the field that treatment for SM is an ongoing process and can take months or years and that the sooner the child receives the appropriate treatment, the sooner the recovery.